LONG-TERM EFFECT OF REPEATED INJECTIONS OF BOTULINUM TOXIN IN CHILDREN WITH CEREBRAL PALSY – A PROSPECTIVE STUDY

Objectives: To prospectively evaluate the long term effect of 4 periodic injections of botulinum toxin A (BTX-A) in children with cerebral palsy (CP).

Methods: BTX-A was injected into lower extremity muscles of 26 children with hemiplegic or diplegic CP according to a protocol of treatment every 6 months within a 2 year period. The clinical assessment before and one month following each injection included Gross Motor Function Measure (GMFM), a modified Ashworth scale and the range of motion of knee extension and ankle dorsiflexion.

Results: Twenty-one of the 26 studied children received 2 injections, 9 received 3 injections and only 3 completed all 4 scheduled injections. The reason for discontinuing treatment was orthopedic surgery (n=17), non-response (n=4) and dropping out (n=2). A beneficial long-term effect was demonstrated by a significant increase of the pre-injection GMFM score of the last observation carried forward as compared to baseline (p<0.05), although no similar change was noted in the pre-injection muscle tone and range of motion. A motor milestone was achieved by 5 of the 26 children during the study. Comparison of pre-and post injection scores revealed a short-term improvement that was statistically significant only after the first and second injections (p<0.05).

Conclusion: This prospective follow-up study indicates that BTX-A injections in children with CP have a long-term effect on groß motor function.